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Kansas Deaf-Blind Forms

Please click the form name or the PDF icon to download and use the forms.

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Application for Deaf-Blind Certification (pdf)
This form is the application for the Initial Certification or Re-certification for Deaf-Blind Eligibility.


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Application for Family Scholarship
Scholarship Application to help supplement some of the registration costs for education and training related to your child’s deaf-blindness.

Request for Technical Assistance
If your child has certain technical needs use this form to request assistance so we can effectively meet your child’s technical needs.

Informal Vision Skills Inventory
Important information to share about what things your child responds to visually and what he or she does to indicate something is seen.

Informal Functional Hearing Evalutation
The Informal Functional Hearing Evaluation (IFHE) is meant to guide the teacher in determining the impact of hearing loss on educational functioning.

Photo and Social Media Consent
Consent form for the KS Deaf-Blind Project and KSSB to use your Child’s likeness on any and all social media platforms.

Kansas State School for the Blind

1100 State Avenue, Kansas City, KS 66102
(913) 305-3000

The contents of this website were developed under a grant from the U.S. Department of Education #H326T180051. However, those contents do not necessarily represent the policy of the U.S. Department of Education, and you should not assume endorsement by the Federal Government. Project Officer, Rebecca Sheffield, Ph.D.

Copyright © 2021 All Rights Reserved. Kansas Deaf-Blind Project

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